Another reason therapists don't know

[tal.b]

the allegory I was thinking of:

"A beggar had been sitting by the side of a road for over thirty years. One day a stranger walked by. "Spare some change?" mumbled the beggar, mechanically holding out his old baseball cap. "I have nothing to give you," said the stranger. Then he asked: "What's that you are sitting on?" "Nothing," replied the beggar. "Just an old box. I have been sitting on it for as long as I can remember." "Ever looked inside?" asked the stranger. "No," said the beggar. "What's the point? There's nothing in there." "Have a look inside," insisted the stranger. The beggar managed to pry open the lid. With astonishment, disbelief, and elation, he saw that the box was filled with gold.

I am that stranger who has nothing to give you and who is telling you to look inside. Not inside any box, as in the parable, but somewhere even closer: inside yourself. "

[Barrett Dorko]

Okay.

I have NEVER claimed (and I know you're aware of this) that ideomotion secondary to Simple Contact is superior in effect, but the premise has been stated and the method is clear.

Well, pretty clear.

[advantage1]

What about those patients with central sensitization with plastic changes within spinal cord and supraspinal regions? Whether we use non-coercive, coercive/passive handling or active/conscious movement, we can't expect these plastic changes to change and resolve immediately. This would require repeated handling and ongoing active movement on the patients part would it not?

[Bas Asselbergs]

Yes, it would require ongoing and practicing of motion - not necessarily always WITH handling.

[Jo Bowyer]

I saw one this morning who is having difficulty upping the aerobic component. She likes to run, but gets a flare up every time she tries. For the present we are sticking to flights of office stairs at sufficient climb rate to change the breathing.

[Evanthis Raftopoulos]

"The premise is that the patient is stuck in protection and needs some help to get to resolution. The method is the provision of novel and non threatening input. I think that's the best we can state in support of any manual therapy (non coercive, passive or active)."

Thank you for this Patrick. This would require a diagnosis of "stuck in protection". Is there a way to successfully identify those who fit this model/diagnosis, or are we generally assuming that experiencing msk manifested pain=stuck in protection?


@all
What stops one from connecting the ideomotor effect or therapeutic movement that we talk about here to any other modality (eg. Needling, e-stim, dnm, manipulation)? is 'simple contact' The preferable way of facilitating 'ideomotion'? Why or why not? My apologies if this sounds repetitive.


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[Diane]

Preferable in terms of being least invasive/most minimalist - less likely to do harm. Not like cervical manipulation for example, or needling, which pokes actual holes in actual tissue and does actual tissue damage.

[Evanthis Raftopoulos]

Thank you Diane.
I'd say hands off is the least invasive in the context of 'therapy'. Why is contact necessary? Wouldn't education alone about the potential benefits of movement have the same general effects?


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[HeadStrongPT]

I always think of Anne Fernald's quote of sound being "touch at a distance" when considering this question.

Thank you Diane.
I'd say hands off is the least invasive in the context of 'therapy'. Why is contact necessary? Wouldn't education alone about the potential benefits of movement have the same general effects?


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[Bryan]

Thank you Diane.
I'd say hands off is the least invasive in the context of 'therapy'. Why is contact necessary? Wouldn't education alone about the potential benefits of movement have the same general effects?


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I'm not sure about "the same" but certainly beneficial. This is the basis for TNE, no?

There's also the Diane-ism, "touch is optional but may be optimal." Something almond those lines.

[gilbert]

@all
What stops one from connecting the ideomotor effect or therapeutic movement that we talk about here to any other modality (eg. Needling, e-stim, dnm, manipulation)? is 'simple contact' The preferable way of facilitating 'ideomotion'? Why or why not? My apologies if this sounds repetitive.

Evan, ideomotion IS active movement. Those modalities you listed are not. DNM by being a gentle hands-on approach can often facilitate ideomotion (in my limited experience). From what you write I wonder if you would find it helpful to elicit some more noticeable non-volitional movement in yourself to see what it feels like. I personally brushed off Barrett's writing about ideomotion for years because I thought it was either 'too unusual' or 'not applicable' to what physical therapy is in my view. But then when alone I tried just touching the top of my left shoulder and 'doing nothing'. I managed to elicit very dramatic and surprising (to me) movement in my left upper extremity.

To your question above, if a light manual contact is enough to encourage increased effortless movement and awareness of the movement, why would that not be the "preferable way of facilitating 'ideomotion' "?

[Barrett Dorko]

Evanthis asks:

Why is contact necessary?

No one says it is, but haven't we had several threads here about the power of expectation?

Hasn't it been anyone's experience that our own self-awareness is enhanced with touch?

[nari]

Patrick,

To your question above, if a light manual contact is enough to encourage increased effortless movement and awareness of the movement, why would that not be the "preferable way of facilitating 'ideomotion'? (gilbert)

Yes, why not?
If a coerced/choreographed movement is done by the patient and/or the therapist, is the evidence of its usefulness shown to be better than eliciting ideomotion?

Nari

[Bas Asselbergs]

Interpersonal touch in an office between therapist and patient is definitely more expected than just education.

Touch appears to add importance to the interaction. Herein lies the benefit AND the danger.

Many patients expect much "more" from PT. Thank goodness for the word-of-mouth referrals that self-select most of my caseload.....

[Jo Bowyer]

Touch is a useful modality as is the right word at the right time. I take case histories from young children many of whom are initially reluctant to be touched by a stranger. I take the matter of consent seriously and on several occasions have sent the child and parents away if I think that consent is withheld. A protective posture with arms across the body and reluctance to look in my direction would prompt me to ask "Have you had enough of this" if I get a nod I say "I would like you to come back and see me in two days".

I will not examine a child unless I see an open posture and expression of ideomotion as we talk together.

As a young physiotherapist I worked for an orthopaedic surgeon who demanded that I increase the range of movement in a five year old girl's knee and said that he would hold me personally responsible if the surgery failed. In those days it wasn't considered necessary to give young children adequate analgesia. The little girl who didn't have much English would lose control of her bladder everytime I walked onto the ward.

Seven years later I saw a small boy with an effusion in his right knee following a ski ing accident. He was OK during the history but screamed when I moved to examine him, having had a bad experience with the consultant. "But I haven't touched you yet" I said. "I know you haven't but I'm not a brave boy". I suggested he come back a couple of days later and it was he who taught me during the following two months much of what I now know about working with children recovering from injury.

Adults will often give verbal consent to examination and treatment, when it is obvious to the observer that the nervous system has not given consent. I see ideomotion as expression of consent, but make sure that I continue to have informed and ongoing verbal consent as well.
It is rare that I see full expression of ideomotion in an adult patient that I have yet to touch.